Background
The Pan American Health Organization/World Health Organization
(PAHO/WHO) Measles and Rubella Risk Assessment Tool identifies areas
that are not meeting programmatic targets for measles and rubella.
Therefore, the results of the risk assessment will guide and strengthen
activities for the sustainable elimination of these diseases, in order
to educate the risk of outbreaks.
This tool assesses risk at the municipal level by summing indicator
points in five categories: population immunity, surveillance quality,
program performance, threat assessment, and rapid response. Each
municipality in the country is assigned a programmatic risk category:
low, medium, high, or very high , based on the final score obtained. The
scoring for each indicator was based on expert consensus. The range of
possible scores goes from 0 to 100 risk points, according to the
following table:
| Low risk |
Less than 26 points |
| Medium risk |
Between 26 and 50 points |
| High risk |
Between 51 and 75 points |
| Very high risk |
More than 100 points |
Risk indicators
- Population immunity: Evaluates susceptibility risk for measles and
rubella using reported administrative coverage for the first and second
doses of measles-mumps-rubella vaccine (MMR1 and MMR2, respectively);
and the coverage obtained in the latest follow-up campaign carried out
in the country. This indicator also includes the proportion of suspected
cases of measles and rubella who were not vaccinated or whose
vaccination history is not known. (Total points = 40)
- Surveillance quality: Evaluates the sensitivity of the municipality
for timely detection and confirmation of measles and rubella cases.
Indicators in this category include the annual reporting rate for
suspected cases of measles and rubella; the proportion of suspected
cases with adequate investigation (home visit within 48 hours after
notification and completion of eight of the 11 key variables); the
proportion of cases with an adequate sample in < 30 days; and the
proportion of blood samples received in the laboratory in < 5 days.
(Total points = 20)
- Program performance: Evaluates specific aspects of routine
immunization services, including administrative coverage indicators for
MMR1 and MMR2; drop-out rate for MMR1-MMR2; and for the first dose of
pentavalent vaccine (diphtheria-tetanus-pertussis [DTaP], hepatitis B,
and Haemophilus influenzae) and MMR1. (Total points = 16)
- Threat assessment: Considers factors that may influence the risk of
introduction and spread of measles and rubella in the population. These
indicators include population density and the presence of vulnerable
groups. (Total points = 12)
- Rapid response to imported cases of measles and rubella: Considers
the presence of a rapid response to imported cases of measles and
rubella. Indicators are measured at the subnational level and include
the presence of a trained rapid response team and the proportion of
hospitals trained to triage and isolate highly suspected cases of
measles and rubella. (Total points = 12)
The tool can be used periodically by managers of national
immunization, epidemiological surveillance, and laboratory programs to
monitor implementation of measles and rubella sustainability strategies
in the country. The tool requires data that is readily available and
routinely collected by immunization and surveillance programs. Results
are visualized through tables and maps, by municipality, with colors
assigned to each risk category. In addition, municipal risk scores can
be displayed by indicator, facilitating a better understanding of the
programmatic weaknesses contributing to the final risk assessment
score.
Sections
Section 1: Overall measles and rubella risk
profile
From 6 municipalities in Belize, 0 (0%) were categorized as very high
risk, 1 (16.7%) were categorized as high risk, 3 (50%) were categorized
as medium risk, and 2 (33.3%) were categorized as low risk.
Table 1a: Number of municipalities in general profile, Belize,
2014-2018.
| Low risk |
2 |
33.3% |
| Medium risk |
3 |
50.0% |
| High risk |
1 |
16.7% |
| Very high risk |
0 |
0.0% |
| Total |
6 |
100.0% |
Section 2: Population Immunity
Table 2a: Number of municipalities with population immunity, Belize,
2014-2018.
| Low risk |
2 |
33.3% |
| Medium risk |
4 |
66.7% |
| High risk |
0 |
0.0% |
| Very high risk |
0 |
0.0% |
| Total |
6 |
100.0% |
Section 3: Surveillance Quality
Table 3a: Number of municipalities under surveillance, Belize,
2014-2018.
| Low risk |
5 |
83.3% |
| Medium risk |
0 |
0.0% |
| High risk |
0 |
0.0% |
| Very high risk |
1 |
16.7% |
| Total |
6 |
100.0% |
Table 3b: Silent municipalities, Belize, 2014-2018.
| Number of silent municipalities |
1 |
| Percentage of silent municipalities |
16.7 |
Section 5: Threat Assessment
Table 5a: Number of municipalities in threat assessment, Belize,
2014-2018.
| Low risk |
0 |
0.0% |
| Medium risk |
4 |
66.7% |
| High risk |
2 |
33.3% |
| Very high risk |
0 |
0.0% |
| Total |
6 |
100.0% |
Section 6: Rapid response to imported cases
Table 6a: Number of municipalities in rapid response, Belize,
2014-2018.
| Low risk |
6 |
100.0% |
| Medium risk |
0 |
0.0% |
| High risk |
0 |
0.0% |
| Very high risk |
0 |
0.0% |
| Total |
6 |
100.0% |
Appendix: Global variables
Global reference data
| Name of country or subnational level |
Belize |
| Year of risk assessment |
2019 |
| Does the country have a trained rapid response
team? |
Si |
| Year of last campaign (YYYY)? |
2005 |
| MMR1 age of administration (months) |
12 |
| MMR2 age of administration (months) |
18 |
| Outbreak |
No |
| Language |
ENG |
Calculated fields
| First year of data |
2014 |
| Last year of data |
2018 |
| Years of assessment |
2014-2018 |
Geoelement
| Shapefiles loaded |
6 |
| Number of subnational levels |
1 |
| Number of municipalities |
6 |
| Population of country in reference year |
398,533 |
| Area (km2) in reference year |
22,965.5 |
